Pia Ginela L. Dalay, Angelo Carl P. Mallari, Tiffany Nicole N. Vital, Mark Dennis Y. De Guzman, Natalie C. Bartolo, Euge M. Bengco, Sofia Denise S. Garcia, Joanna Khate P. Ludovice, Kiana Angelica A. Parungao, Adrienne Gail S. Pring, Jeffrey V. Esteron, Dennison Jose C. Punsalan
Background: Advance care planning (ACP) allows individuals to make informed decisions about their future healthcare, yet it remains underutilized in the Philippines due to cultural beliefs, limited awareness, and the lack of legal and institutional support. ACP is often discussed only with elderly or terminally ill patients in hospitals, rather than being promoted as a routine, family-centered process across all ages. This study aimed to explore the knowledge, attitudes, and determinants of ACP practice among Filipino families in a selected community in Angeles City.
Methods: A descriptive research design with multi-stage sampling was used to survey 377 household heads aged 18 and above who had lived in the community for at least six months. A validated questionnaire adapted from Cheng et al. [2022] was used to assess ACP knowledge, attitudes, behavioral intentions, and influencing factors. After receiving ethical clearance from the Ethics Review Committee, the questionnaire was administered in a selected community in Angeles City. The questionnaires were administered and retrieved from February 13, 2025 to March 22, 2025. This questionnaire also underwent cultural validation from a progressive care nurse, social insurance officer III, and community health nurse. The data from 377 respondents were statistically analyzed in the Statistical Package for the Social Sciences (SPSS) version 30 using frequency, percentage, mean (M), standard deviation, and ranking.
Results: The results showed that respondents had moderate knowledge of ACP, with a M score of 5.31. While they were aware of basic patient rights such as accepting or refusing treatment, many lacked understanding of formal legal tools like advance directives (ADs). Attitudes toward ACP were generally favorable; respondents agreed that ACP enhances preparedness (M =4.41), reduces family burden (M =4.40), and improves quality of life (M =4.35). However, willingness to engage in formal documentation scored slightly lower (M =3.97). Behavioral intentions to participate in ACP were influenced most by family members, particularly children and spouses, and healthcare professionals. Emotional discomfort, religious beliefs, and cultural norms were identified as key barriers to engagement.
Conclusions: The findings underscore the importance of integrating ACP into routine community health education and nursing practice, encouraging proactive dialogue regardless of age or illness status. Moreover, there is a pressing need for national policies that support ACP implementation and accessibility across different settings. Culturally sensitive approaches and family-centered communication strategies are essential to normalize ACP and empower individuals to make values-based healthcare decisions. Future research should also explore region-specific barriers and facilitators to ACP, in order to develop culturally appropriate strategies that enhance community engagement and promote informed healthcare decision-making.
